General Article: Government Funding of IVF

Government support of in vitro fertilization (IVF) has been an issue for decades, and the federal government’s unwillingness to fund IVFwork has had consequences for both the pace and direction of IVF development.

Setting Research StandardsIn England the answer was simple enough: in 1971 the Medical Research Council outright denied a funding request from Robert Edwards and Patrick Steptoe, insisting that further research of animals was needed before IVF involving humans could even be considered. But in America, the issue of government grants proved considerably more complex. In 1959, President Dwight Eisenhower had stated that birth control was “not a proper political or government activity or function or responsibility.” IVF, which also dealt with beginning-of-life issues, was met with similar government avoidance. In 1966 the National Institutes of Health (NIH) had set out general standards for all research performed by its grantees, and in the same year, the Department of Health, Education, and Welfare issued an order governing all clinical research conducted with federal grants.

Controversies Involving FetusesBut was IVF a fit subject for research grants? The first group commissioned to make a recommendation, the 1971 Human Embryo Research Panel, thought so; it concluded that under certain conditions, research involving fetal and embryonic tissue should be supported. But the research panel’s report to NIH was submitted and then ignored. In 1973 another panel expressed similar backing for IVF studies, but then part of a 1974 law pushed by Senator Edward Kennedy placed a temporary moratorium on fetal research. Although IVF funding was not specifically mentioned, it tended to get caught up in all controversies involving fetuses; and, just a year after the Supreme Court’s Roe v. Wade decision that legalized abortion, there were plenty of controversies. Anti-abortion activists were quick to oppose anything involving fetal or embryonic research as well.

Delays and HearingsOne of the Kennedy law’s provisos was the creation of a national commission to examine the temporary fetal research ban, and in 1975 the commission recommended allowing such research. But it also suggested that all proposed research would first have to be reviewed by a national Ethics Advisory Board, a suggestion the government quickly adopted and extended to IVF funding as well. Unfortunately for those who wanted to conduct such research, the board wasn’t even created until January 1978, by which point the grant applications of some scientists, like Pierre Soupart of Vanderbilt, had been sitting in limbo for years. The board held 11 public hearings and concluded in a March 1979 report that IVFresearch shouldn’t be forbidden, even when it involved the destruction of embryos. Still the government dragged its feet, and still IVF remained unfunded. Soupart died in 1981, eight years after submitting his grant application, and America’s first clinic opened in Norfolk, Virginia, operating without any federal funds. America’s first test tube baby was born in December 1981, and the IVF movement grew exponentially after that, proceeding all along without federal help.

ConsequencesThe federal government’s reluctance to fund IVF research had a number of consequences. First, IVF’s development occurred outside federal supervision, fueled by market economics but without the guidelines and review process that federal grants would have entailed. Clinics could decide who to treat and what to charge, potentially limiting availability to those outside the social mainstream or with modest means. IVF became, in bioethicist Arthur Caplan’s words, “the wild, wild west of medicine.” Second, even as IVFprocedures entered the mainstream, the government’s hands-off policy did not prevent future controversies; as the 21st century began, a new firestorm erupted over research on stem cells derived from human embryos. While allowing the use of stem cell lines already in existence, President George W. Bush in August 2001 chose not to fund further research that would involve the destruction of human embryos. In May 2005 the House of Representatives passed a bill that would expand funding beyond the Bush limits, but the president threatened to veto it. In spite of the veto threat, the House voted overwhelmingly in favor of the bill in both 2005 and 2006. Regardless of the outcome of this more recent controversy, it’s clear that Americans will be debating the ethics of using human embryos in research for a long time.